Acne inversa (also called as hidradenitis suppurativa) is a non-contagious chronic inflammatory disease of the skin, characterized by blackheads, and painful red lesions or sores. It usually affects the armpits, area beneath the breasts, groin, inner thighs and buttocks. It occurs in the deep part of skin around hair follicles and oil glands.
Acne inversa is a severe type of acne that tends to make its first appearance after puberty, and persists for years. With proper treatment, the symptoms can be managed and new lesions can be prevented from developing.
Risk Factors Of Acne Inversa
Acne inversa occurs more commonly in females and those between puberty and 40 years of age. If you have a family history of acne inversa, you are at greater risk. Several trigger factors have been identified. They are tight clothing, use of deodorants and depilation products, shaving of affected area, use of drugs like oral contraceptives and lithium, and hot and humid climate.
Causes Of Acne Inversa
Acne inversa occurs due to blockage of the openings of hair follicles and oil glands by fluid, dead cells and matter released by nearby sweat glands. But it is not known what leads to the blockage. Poor hygiene does not cause it. It runs in families, so genetic susceptibility is postulated.
Excess of sex hormones, mainly androgens, is also implicated as a cause. Smoking and obesity are thought to be contributing factors. Sometimes acne inversa occurs in association with diseases like Crohn’s disease and hyperthyroidism.
Symptoms Of Acne Inversa
Single area or more than one area may be affected. It typically occurs in armpits, anal region and groin where sweat and oil glands are in abundance. It can also affect areas where skin rubs against itself, such as inner thighs, beneath the breasts, and between the buttocks. Affected skin will have blackheads, often in pairs, on small areas of pitted skin.
There will be painful red lesions or bumps, which enlarge and break open, draining pus. Painful hard lumps can be present, which can become enlarged and inflamed, and tend to persist for years together. Open sores may heal with scarring. Symptoms are worsened by excess sweating, excess weight gain, stress, heat and hormonal changes.
Complications Of Acne Inversa
If the disease is chronic and severe, it can lead to complications. A network of sinus tracts can develop, which will prevent the healing of sores.
Hyperpigmentation of affected areas can occur. Thick scars can form, which may limit the movement. Pain can limit the movement of the affected arm or leg. Bacterial infection of the affected skin can lead to cellulitis. A more severe complication is skin cancer in late stages of the disease where fistulas are left untreated.
Treatment Of Acne Inversa
Acne inversa has no cure at present. Lifestyle changes like avoidance of refined carbohydrate foods, cessation of smoking, and weight loss in those who are overweight can have a beneficial effect on the disease. Medications that are used are antibiotics like rifampicin and clindamycin, corticosteroids, anti-androgens like ethinyl estradiol and cyproterone acetate, and anti-TNF-alpha drugs like infliximab and etanercept.
Incision and drainage of lesions can be resorted to in cases where a single area is affected. If the disease is not responding and has become chronic, then wide surgical excision can be done, followed by skin grafting. Alternative therapies include zinc gluconate (30 mg thrice daily) and turmeric capsules.